Provider Demographics
NPI:1245446236
Name:LOPEZ-NAVARRO, EDUARDO LUIS (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:LUIS
Last Name:LOPEZ-NAVARRO
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EAST VALLEY MALL, SUITE 204
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731
Mailing Address - Country:US
Mailing Address - Phone:626-582-8912
Mailing Address - Fax:626-582-8895
Practice Address - Street 1:11001 VALLEY MALL STE 204
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2620
Practice Address - Country:US
Practice Address - Phone:626-582-8912
Practice Address - Fax:626-582-8895
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist